Persistent COVID-19 Symptoms at 6 Months After Onset and the Role of Vaccination Before or After SARS-CoV-2 Infection
Authors: Stephanie A. Richard, Simon D. Pollett, Anthony C. Fries, Catherine M. Berjohn, Ryan C. Maves, Tahaniyat Lalani, Alfred G. Smith, Rupal M. Mody, Anuradha Ganesan, Rhonda E. Colombo, David A. Lindholm, Michael J. Morris, Nikhil Huprikar, Christopher J. Colombo, Cristian Madar, Milissa Jones, Derek T. Larson, Samantha E. Bazan, Katrin Mende, David Saunders, Jeffrey Livezey, Charlotte A. Lanteri, Ann I. Scher, Celia Byrne, Jennifer Rusiecki, Evan Ewers, Nusrat J. Epsi, Julia S. Rozman, Caroline English, Mark P. Simons, David R. Tribble, Brian K. Agan, Timothy H. Burgess, Terry Merritt, Susan Chambers, Cristin Mount, Michael Stein, Catherine Uyehara, Heidi Adams, Patrick Hickey, Edward Parmelee, Mark Fritschlanski, Tim Chao, Richard Chapleau, Monica Christian, Kelsey Lanter, Jennifer Meyer, John Iskander, Kathryn Lago
Journal: JAMA Network Open (2023)

Importance Understanding the factors associated with post-COVID conditions is important for prevention. Objective To identify characteristics associated with persistent post–COVID-19 symptoms and to describe post–COVID-19 medical encounters. Design, Setting, and Participants This cohort study used data from the Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases With Pandemic Potential (EPICC) study implemented in the US military health system (MHS); MHS beneficiaries aged 18 years or older who tested positive for SARS-CoV-2 from February 28, 2020, through December 31, 2021, were analyzed, with 1-year follow-up. Exposures SARS-CoV-2 infection. Main Outcomes and Measures The outcomes analyzed included survey-reported symptoms through 6 months after SARS-CoV-2 infection and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis categories reported in medical records 6 months following SARS-CoV-2 infection vs 3 months before infection. Results More than half of the 1832 participants in these analyses were aged 18 to 44 years (1226 [66.9%]; mean [SD] age, 40.5 [13.7] years), were male (1118 [61.0%]), were unvaccinated at the time of their infection (1413 [77.1%]), and had no comorbidities (1290 [70.4%]). A total of 728 participants (39.7%) had illness that lasted 28 days or longer (28-89 days: 364 [19.9%]; ≥90 days: 364 [19.9%]). Participants who were unvaccinated prior to infection (risk ratio [RR], 1.39; 95% CI, 1.04-1.85), reported moderate (RR, 1.80; 95% CI, 1.47-2.22) or severe (RR, 2.25; 95% CI, 1.80-2.81) initial illnesses, had more hospitalized days (RR per each day of hospitalization, 1.02; 95% CI, 1.00-1.03), and had a Charlson Comorbidity Index score of 5 or greater (RR, 1.55; 95% CI, 1.01-2.37) were more likely to report 28 or more days of symptoms. Among unvaccinated participants, postinfection vaccination was associated with a 41% lower risk of reporting symptoms at 6 months (RR, 0.59; 95% CI, 0.40-0.89). Participants had higher risk of pulmonary (RR, 2.00; 95% CI, 1.40-2.84), diabetes (RR, 1.46; 95% CI, 1.00-2.13), neurological (RR, 1.29; 95% CI, 1.02-1.64), and mental health–related medical encounters (RR, 1.28; 95% CI, 1.01-1.62) at 6 months after symptom onset than at baseline (before SARS-CoV-2 infection). Conclusions and Relevance In this cohort study, more severe acute illness, a higher Charlson Comorbidity Index score, and being unvaccinated were associated with a higher risk of reporting COVID-19 symptoms lasting 28 days or more. Participants with COVID-19 were more likely to seek medical care for diabetes, pulmonary, neurological, and mental health–related illness for at least 6 months after onset compared with their pre-COVID baseline health care use patterns. These findings may inform the risk-benefit ratio of COVID-19 vaccination policy.